MEDICARE: DEBBIE S COY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2297	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407874993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBBIE S COY OD

Provider Business Mailing Address
First Line	:	330 E HIGHWAY 62
Second Line	:
City	:	FORT GIBSON
State	:	OK
Zip	:	74434-8446
Country	:	US
Telephone Number	:	918-478-8888
Fax Number	:	918-478-3465

Provider Business Practice Location Address
First Line	:	330 E HIGHWAY 62
Second Line	:
City	:	FORT GIBSON
State	:	OK
Zip	:	74434-8446
Country	:	US
Telephone Number	:	918-478-8888
Fax Number	:	918-478-3465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/12/2012

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Directions to “ DEBBIE S COY OD” Practice Location

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